Reducing severe aggressive and self-injurious behaviors with functional communication training.

Functional communication training is a behavioral intervention that incorporates a comprehensive assessment of the communicative functions of maladaptive behavior with procedures to teach alternative and incompatible responses. In two studies severe aggressive and self-injurious behaviors exhibited by two adult men with mental retardation were reduced through the implementation of functional communication training. In both studies, these reductions came after years of less successful nonaversive and aversive interventions and generalized across staff, new environments, and increasing task demands. The role of this training as a refinement of the traditional differential reinforcement of other behavior and as an alternative to the use of aversive interventions was discussed.

Assaultive behaviour: before it happens....

This paper reviews risk factors associated with assaultive behaviour. The author will look at specific risk factors to evaluate when assessing patients with an aggressive potential and he will examine patient-staff relationships that might trigger assaultive behaviour. The author believes that a better knowledge of risk factors allows us to develop preventive attitudes, and these will be discussed in the latter part of this paper.

A prospective study of patient assaults on nursing staff in a psychogeriatric unit.

A 27 month prospective study concerned with aspects of patient-nurse assaults on the geriatric unit (three wards) of a Canadian provincial mental hospital was conducted. The findings were compared with those for the other words. The incidence of assaults was approximately the same in both areas (0.24-0.25 assaults/occupied bed/year respectively). In the former, the commonest diagnoses associated with assaultiveness were dementia followed by schizophrenia and in the rest of the hospital, schizophrenia. However, when base rates of assaultiveness were calculated allowing for the disproportionate number of patients with these conditions, mental retardation, and dementia were approximately twice as likely to be related to assaultiveness as schizophrenia; regardless of where the patients were located. In the geriatric unit attacks were more likely when patients were being physically guided or led and during the administration of drugs; elsewhere whilst physical restraints were being applied. In both hospital areas a comparatively small number of patients accounted for a disproportionate number of assaults and a few nurses were attacked repeatedly. The majority of episodes were trivial but in isolated cases personnel were off work for several months. The discussion focuses on the possibility of generalizing results.

Animal depression model by neonatal clomipramine: reduction of shock induced aggression.

Clomipramine, administered to neonatal rats, has been reported to produce adult behavioral and REM sleep abnormalities. They include decreased sexual behavior, increased ambulation in the outer part of an open-field arena, increased REM sleep % of total sleep time, and in descriptive data, short REM latency, and increased REM phasic events. Since these abnormalities resemble some found in human endogenous depression, we have hypothesized that the adult rats represent an animal model of depression. Diminished aggressive behavior is a common characteristic of endogenous depression. This study tested the validity of the animal depression model by determining in rats the effect of neonatal clomipramine on adult shock-induced fighting. Experimental rats were treated neonatally with clomipramine and control rats were treated neonatally with saline. When they matured, compared with control rats, experimental rats had significantly fewer offensive fighting responses, and significantly more defensive fighting responses. The findings add some support to the validity of the animal depression model produced by neonatal clomipramine.

[Aggressive conflicts in physician-patient relations in the course of inpatient treatment--considerations based on case examples]. / Aggressive Auseinandersetzungen in der Arzt-Patient-Beziehung während einer stationären Behandlung--Uberlegungen anhand von Fallbeispielen.

Physical attacks of patients against the treating therapist during hospitalisation are severe complications in the treatment process, creating a variety of problems for all those involved. Partly due to taboo, literature almost does not deal with physical attacks, although they are likely to be a rather common phenomenon. Contrary to this tendency, it seems fair to say that as a treatment problem these situations deserve special attention. Causes of aggressive escalation will be examined by means of two case studies. The question as to how to prevent physical attacks as well as ways to deal with them will be reconsidered.